Health

In many cases of liver cancer, surgical removal of the tumor is impractical; sometimes the entire liver may be removed. This, of course, necessitates the transplantation of another liver into the patient. In many cases, however, this treatment fails since tiny colonies of cancer cells have already spread to distant sites in the body. There has been some suggestion that for certain patients undergoing liver transplantation for cancer, recurrence and metastasis will occur more rapidly than they would otherwise; this is presumed to be the result of the immunosuppressing drugs necessary for a successful transplantation procedure. The growth of recurrent and metastatic cancer was investigated in detail in 20 patients who underwent liver transplantation for hepatocellular carcinoma, a form of liver cancer. A total of 27 cancerous lesions were measured in the 20 patients at periods ranging from 12 to 124 months after surgery. Fifteen lesions were found in the transplanted livers and 12 in the lungs. The dimensions of the cancerous growths were determined from images obtained using CT scanning, and the changes in these dimensions could then be used to estimate the rate of growth of the lesions. A convenient measure for the rate of growth is the doubling time, the period needed for a growing tumor to double its size. It was found that the metastatic liver cancers growing in the lungs doubled in size over an average of 44 days. Similarly, the malignant tumors within the transplanted livers doubled in size in just under 38 days. For purposes of comparison, the tumor doubling time was measured in five patients with liver cancer who were treated surgically, but not with transplantation. In this group, the average tumor doubling time was 274 days. The cancers are clearly growing more rapidly among the patients who received liver transplants as a part of their treatment. Transplantation surgery requires cyclosporine and steroid treatment to reduce the risk of transplant rejection. It is thought that this immunosuppressive therapy impairs the ability of the body to fight the growth of tumor cells, enabling the cancers to grow more rapidly in patients who have received transplants. (Consumer Summary produced by Reliance Medical Information, Inc.)

There is some suggestion that the use of oral contraceptives may be associated with an increased risk of hepatocellular carcinoma, a form of liver cancer. The risk is not great, but nevertheless, the concern is heightened by the discovery that liver cell adenomas, which were rare prior to the introduction of oral contraceptives, are now far more common. Liver cell adenomas are benign tumors, but some pathologists believe that they represent a premalignant condition and may, after several years, progress to become actual liver cancer. Investigations have established clearly that when oral contraceptive use is discontinued, the liver adenomas regress and disappear, indicating that the supposed progression towards cancer is not irreversible. These observations raise several questions about the relationship between oral contraceptives, benign liver adenomas, and hepatocellular carcinoma. To clarify the relationships, a pathological study was conducted of liver specimens from a total sample of 1,673 patients with liver masses. Three of 99 liver cancers were from women who used oral contraceptives for periods of 10, 11, and 12 years. All nine specimens of liver adenoma found were from women who had used oral contraceptives for periods ranging from five to 10 years. A microscopic examination of the liver specimens revealed that two of the nine adenomas contained areas of liver cell dysplasia. Dysplasia is an abnormal tissue condition, and in the present cases the liver dysplasia revealed great similarity to actual liver cancer. These two specimens were from women who had taken oral contraceptives for eight and 10 years. It would seem that oral contraceptive use promotes the formation of liver adenomas, but with fewer than five years of oral contraceptive use these adenomas remain reversible. With longer periods of contraceptive use, the adenomas risk developing areas of liver cell dysplasia, which may actually represent the true premalignant condition which will inevitably develop into liver cancer with time. It may be advisable for women who have used oral contraceptives for a period longer than eight years to consider discontinuation. (Consumer Summary produced by Reliance Medical Information, Inc.)